With the threat of using chemical weapons now off the table, the Syrian regime has apparently turned to even more punitive actions to force rebellious citizens into submission: blockade-induced starvation. For months now the government of President Bashar Assad has encircled the rebel-aligned suburbs south and east of the capital Damascus, cutting off road access, telephone connections, water and electricity. But in the wake of the Aug. 21 chemical-weapon attack on the area, which rebels and the West blame on the regime, the government tightened the blockade even further, increasing fears that mass starvation might lead to even more deaths than the estimated 400 to 1,400 victims of the chemical attacks. Already six have died from malnutrition, according to activists, and as winter approaches, conditions are likely to worsen. One rebel brigade says it has dedicated its forces to breaking the siege in Moadhamiya, a town about 10 km from Damascus that has been under siege for more than six months.

“The situation is bad in Moadhamiya; it’s a real disaster,” Oraba Idriss, commander of the 1,200-strong Maghaweer Brigade tells TIME via Skype. “People lack for everything. They didn’t even have bread to eat until we were able to bring them some wheat and flour.” According to the Moadhamiya Media Center, an activist group that works with Idriss, six people have died of starvation in the past month, including four children. Another dozen children are in medical clinics, suffering from acute malnutrition. One video, released by the media center and posted on YouTube and Twitter, shows the emaciated body of an 18-month-old girl they claim succumbed to starvation on Sept. 23. Whatever power there is comes from generators running off limited supplies of fuel that are smuggled in. Transporting something as simple as flour or fuel across enemy lines requires days of strategic planning and a large degree of luck. “Every mission to Moadhamiya is like a suicide mission for us,” says Idriss. “We have to go around tens of checkpoints, and if they discover us, death is inevitable.” In the past month he has lost four men. Still, he says, the sacrifice is worthwhile. “Hundreds, if not thousands, of civilians are starving in Damascus, and if we don’t risk our lives for them, they will simply die.”

Update : A spokesman from the Moadhamiya Media Center disputes Idriss’ claim to have brought in food supplies, saying the siege has remained unbroken for four months. “Nothing has entered Moadhamiya but Assad’s bombs and shells,” says Qusai Zakarya. “Nothing leaves but civilian lives.” Idriss counters that just two weeks ago he was able to deliver a supply of weapons and cash. Given the lack of journalistic access, it is impossible to verify either account. Still, both agree on the toll the siege is exacting from Moadhamiya’s civilians. “It is a living hell,” they both said, in subsequent interviews conducted over Skype.

The use of siege warfare is not new in Syria: water lines to the city of Hama have been cut on and off for more than a year now, and in the north rebel forces have used the tactic in attempts to capture government military bases. Even where the government has allowed humanitarian access to provide food, it has refused to allow the transport of medical supplies, lest they be used to heal wounded fighters, say aid agencies. But nowhere has the blockade been as complete as it is in Moadhamiya, one of the first towns around Damascus to rise up peacefully against the regime. Government forces have completely surrounded the area, say local activists. “What the regime is doing is mass punishment for all the people who chanted once for the downfall of the regime,” says Idriss.

International aid organization Save the Children said in an appeal on Sept. 23 that more than 4 million Syrians, more than half of them children, do not have enough to eat. “The children of Syria have been shot, shelled and traumatized by the horror of war,” said Roger Hearn, Save the Children’s regional director for the Middle East. “The conflict has already left thousands of children dead, and is now threatening their means of staying alive.” The Syrian National Coalition, a group of opposition parties based in Turkey, joined the call, accusing government forces of tightening the siege on the Damascus suburbs in a statement released on Sept. 30. “Assad’s forces are starving people to death in those areas … The specter of famine looms on the horizon.” On Wednesday the U.N. Security Council urged the Syrian government to provide humanitarian access to civilians trapped in the country’s conflict, but the government maintains that Moadhamiya is occupied not by civilians but by “terrorists,” its term for antiregime fighters. Moadhamiya’s prewar population of 70,000 has been reduced to 12,000. Most residents have already fled, joining the 8 million Syrians, more than a third of the population, that the U.N. now estimates to have left their homes in a war that has claimed 110,000 lives. Those who remain in Moadhamiya either don’t have the money to leave, or have nowhere to go, says Idriss. In some ways the mass migration is a blessing, he adds. With winter coming, few families would be able to survive on the meager portions of food and heating oil that his brigade would be able to smuggle in.

Getting essential items across the sniper-monitored no-man’s land and past government checkpoints requires a combination of guile, cash and bravery, says Idriss. His men will watch the government checkpoints for hours, waiting for new guards to replace those getting off shift — a two- to three-minute window that offers barely enough time to dart past lugging crates of goods. “Some of the soldiers sympathize with the revolution and some others are bribed to allow us to cross. But you cannot bribe all the checkpoints and soldiers,” says Idriss. Locals from inside working with the Idriss’s brigade court the most corrupt regime generals, spending days or even weeks to get them to accept bribes — sometimes up to 25% of the value of the goods. “But the problem is when this general is deployed into another area, then we have to start it all over again and this means no food for the besieged people,” sighs Idriss.

Sometimes his men cross under the cover of darkness, and sometimes under the cover of nearby government shelling — a risky method. There is nothing worse than the heartbreak of seeing a shipment of food, medical aid and weapons destroyed by an errant shell, especially since the goods are already so hard to come by, even in areas not under siege, says Idriss. Shipments can take days or even weeks to put together. Supporters from Western and Gulf nations donate most of the items. Even then, he says, “Whatever we deliver is not enough and it doesn’t make more than 20% of the actual needs of people.” Once across the blockade lines, Idriss’s men hand the goods over to a local committee in charge of delivering aid to the community. In exchange they are given a slip of paper. Not a receipt, but a new list of necessary items. And the whole process starts again.

Aryn Baker is the Middle East Bureau Chief for TIME, covering politics, society, culture, religion, the arts and the military in the greater Middle East, including Pakistan and Afghanistan. She currently resides in Beirut, Lebanon.